AMD eBulletin 28 June 2019
Communities of Practice
The RACP strategic plan 2019-2021 includes as a key action point under its first goal of “improving members’ experience and offering an enhanced sense of membership” the enhancement of “connections between members by piloting online communities”.
Although everyone today has experience of online communities in some form or other there is perhaps less awareness of the contribution they may make to the work we do as physicians. In addition, many Fellows and trainees may not be familiar with what has now become a large body of work in educational theory devoted to identifying ways in which internet-based resources can be used to enhance group outcomes.
The lack of clarity is partly due to the fact that the expression 'online community' refers to a very wide range of internet-based interactions, while the applications that might be of specific relevance to physicians are more specific. To explain this, it is useful to refer to the concept of 'communities of practice' and to examine how the latter may take shape within an internet-based context. It is the establishment of such 'virtual' communities of practice that holds most promise for our organisation.
An online community is merely a set of connections established through the internet that enables some kind of relationship. It encompasses chat rooms, informal readership groups, loosely defined marketing target groups, and subscribers to social media platforms. A 'community of practice', by contrast, is a more rigorous concept that was first developed in the early 1990s as part of a theory of education that stressed the importance of relationships and dialogical interactions in the formation of knowledge. The underlying idea is that knowledge does not arise primarily through abstractly conceived processes of cognition but is rather the result of the sharing of experiences through progressively refined methods of thinking and analysis within practical contexts of action.
Within medicine, the concept of a community of practice seems very natural, because this is always how clinical education has been conducted. Indeed, the concept of clinical medicine itself presupposes the possibility of a community of practitioners who can communicate with each other about their experiences in order to discern common collections of symptoms and signs. These communities not only shape knowledge but also provide the contexts within which individual doctors develop shared values, learn how to respond to difficult or traumatic personal experiences, and provide support and guidance to each other.
The embeddedness of communities of practice within online communities is a novel phenomenon, and the details of how such a process might most effectively work and most fruitfully be applied remain to be clarified. This is the work that is currently being undertaken within the RACP. A variety of purposes has been identified, including the conduct of educational programs, sharing of experience in highly specialised areas of practice, the formation of active communities around particular areas of social or clinical interest, and information-gathering processes to support professional development and research.
Existing social media platforms often facilitate sharing of information or data, typically in an abbreviated form, but rarely support the kinds of deep conversations and practical collaborations that are expected within traditional communities of practice. Perhaps surprisingly, the development of software environments with sufficient complexity and flexibility to allow such interactions remains incomplete.
In addition to the facilitation of complexity, there are various issues and challenges that need to be addressed. How to structure an online community of practice, to determine membership, to facilitate or moderate interactions, and to evaluate outcomes and ensure ongoing evolution and development remain contentious issues. There are also questions about the ethical dimensions of a community, including how to ensure trust, confidence and a sense of safety while avoiding the excesses of power and personal interest and breaches of confidentiality and privacy.
Assuming all these challenges can be met, what applications can we envisage within the RACP context? The possibilities here are almost unlimited. Online communities of practice could be formed comprising trainees wishing to share both fruitful and difficult experiences in their hospital work; of a craft group wishing to collect information about changing clinical patterns; of women identifying particular concerns they encounter, including workplace relationships and experiences of abuse; of Fellows seeking to share practical knowledge about a new drug or therapeutic technique; of doctors looking for ways to contribute to addressing the problem of climate change; of trainees and Fellows interested in developing a career in global health; of physicians wishing to develop capacity in clinical ethics; of Fellows and trainees seeking to enhance the institutions and processes of the College itself.
The RACP online communities of practice project is an important one which has significant potential implications and outcomes. It has the potential to renew and refresh one of the most basic tenets of the College itself, which is that it exists primarily to provide a process by which physicians can come together to engage, communicate, support and learn from each other in order to enhance both their own experiences and their service to the wider community.
Professor Paul Komesaroff FRACP AM
President Adult Medicine Division
Telephone: +61 (0)417 55 26 59
If members are interested, references can be provided to the academic literature regarding the models discussed in this post. As always, I am keen to receive comments, thoughts, and suggestions about the ideas contained in this article.
I would like to take this opportunity to congratulate New Zealand Chapter Fellow, Dr Christine Roke, on being awarded an Officer of the New Zealand Order of Merit in the Queen’s Birthday Honours for her services to sexual and reproductive health. Congratulations Dr Roke!
The Chapter Committee met on 14 June at the RACP office in Sydney and begun planning for the 2020 Annual Scientific Meeting (ASM). The AChSHM 2020 ASM will be held in Sydney on Saturday, 20 March 2020 with the Trainees’ Day being held the day before on Friday, 19 March. We look forward to releasing more details in the coming months.
Last week I met with NSW Chief Health Officer Dr Kerry Chant and Ministry of Health staff to discuss the syphilis epidemic in rural and remote Australia and NSW preparedness.
The AChSHM Research Entry Scholarship is valued at up to $40,000 for one year. It aims to encourage and support the promotion of research in the field of sexual health medicine. All AChSHM Fellows and trainees are eligible to apply, with applications closing on Monday, 15 July 2019.
The Chapter Committee will next meet via teleconference on Thursday, 5 September 2019. If you have any feedback or issues you would like to raise with the Committee, please don’t hesitate to contact us through our secretariat at firstname.lastname@example.org.
Associate Professor Catherine O’Connor
Australasian Chapter of Sexual Health Medicine
I would like to draw members' attention to the work of the Australian and New Zealand Society of Palliative Medicine (ANZSPM). As most members would be aware, the ANZSPM is a society for medical practitioners training and working in palliative medicine. It aims to improve health outcomes by working with and influencing the system and community around the person with a life-limiting illness. ANZSPM facilitates professional development and support for its members, promotes the practice of palliative medicine and advocates for those who work in the field. Members are offered discount rates on the biennial ANZSPM conference and ANZSPM Medical & Surgical Update in alternate years, and the ANZSPM organises a minimum of two trainee days per year in Australia and New Zealand. For more information please visit the ANZSPM website.
The Chapter will be holding a Fellows’ Update at the upcoming Oceanic Palliative Care Conference at the Perth Convention Centre from Tuesday, 10 to Friday, 13 September 2019. The Fellows’ Update will be a breakfast meeting on Friday, 13 September. It is an opportunity for members to come together for a general update on Chapter activity and will act as a forum for Fellows and trainees to ask any questions or express any concerns. I hope to see you there.
The AChPM Committee will next meet via teleconference on Friday, 16 August 2019. If you have any feedback or comments for the Committee, please don't hesitate to contact us through our secretariat at PallMed@racp.edu.au.
Professor Greg Crawford
Australasian Chapter of Palliative Medicine
The Chapter Committee met on 21 June at the RACP office for a productive meeting where we discussed the feedback from Fellows on the draft Addiction Medicine Evolve List of low value clinical practices. The Committee has revised the list and we hope to release this in the coming weeks.
At this meeting the Committee also discussed the South Australian Controlled Substances (Youth Treatment Orders) Amendment Bill 2018, the Victorian Legislative Council’s Inquiry into the use of Cannabis in Victoria, and the NSW Special Commission of Inquiry into the Drug ‘Ice’.
The next International Medicine in Addiction (IMiA) Conference will be held in Sydney in March 2021. IMiA is a joint initiative of the Royal Australian and New Zealand College of Psychiatrists, the Royal Australian College of General Practitioners (RACGP), and the AChAM. In 2021 the RACGP will be the lead College, with Dr Hester Wilson as the Lead Convenor.
If you have any feedback, questions or comments for us, you can get in touch with the Committee via our secretariat at AddictionMed@racp.edu.au.
Dr Martyn Lloyd-Jones
Australasian Chapter of Addiction Medicine
A casual vacancy is available for the position of RACP Trainee Board Director.
The successful candidate for the Trainee Director position is appointed by the Board and will fill the position until the conclusion of the College’s Annual General Meeting in May 2020.
Visit the website for eligibility criteria and nomination details.
Nominations close on Monday, 8 July.
All eligible trainees are encouraged to nominate.
You are invited to join RACP President Associate Professor Mark Lane and your RACP Board at an informal meeting where you will have the opportunity to engage in conversation and network with other Fellows and trainees.
When: Thursday, 11 July 2019 from 6.15pm to 7.15pm with refreshments being served from 5.30pm.
Where: The Green Room, Level 1 next to the Westmead Education and Conference Centre at Westmead Hospital, Corner Hawkesbury Road and Darcy Road, Westmead NSW 2145.
Spaces are limited, so please RSVP by close of business on Thursday, 4 July 2019 to email@example.com.
This is an open invitation for RACP trainees and Fellows, so please feel free to share this within your network. A summary of previous Conversations with the Board events can be found through the following links:
Regrettably the College is unable to provide support for travel and accommodation for this event.
The AMA has inducted seven new members into the AMA Roll of Fellows, in recognition of their outstanding contributions to both the medical profession and the AMA. New inductee includes AMD physician Professor Brad Frankum OAM.
"hominum servire saluti” - to serve the health of our people
The annual awards for outstanding contributions made by members of the College in their respective fields are of special importance and highly valued by their recipients. Our College and the broader medical community benefit in many different ways and in recognition of this, the criteria for The John Sands Medal and The College Medal have been changed to clearly define these differences.
Nominations are now open for:
- The John Sands Medal recognises a Fellow who makes a significant contribution to the welfare of the RACP and its members.
- The College Medal recognises a Fellow who makes a significant contribution to medical specialist practice and improving the health of people.
- Howard Williams Medal recognises a Fellow has made an outstanding contribution to improving the health of children and young people in Australia or New Zealand.
Applications for this year’s Trainee Research Awards will open on 1 July 2019. The Trainee Research Awards provide a wonderful opportunity for trainees to do an oral presentation of their research at a regional event, and if selected, to also present at the 2020 RACP Congress in Melbourne in May.
For further details on our medals and prizes, please visit the Foundation webpage.
Trainees are invited to submit abstracts for oral presentation. Winners are invited to present at RACP Congress 2020 in Melbourne.
Winning abstracts will be published in Congress supplement of Internal Medicine Journal or Journal of Paediatric Medicine.
For full details visit the College website.
At the College Policy & Advocacy Council meeting held in May, a bi-annual report of the College’s policy and advocacy activity was released. The meeting communique is available on the College website.
The report contains detailed updates on policy priorities, which includes both CPAC led items and Divisions, Faculties, Chapters and Regional activity.
Presentation videos of selected sessions from RACP Congress 2019 are now available. You are also able to view all presentation slides. Selected sessions and slides have only been released where approval has been given by the presenters.
We are now planning for RACP Congress 2020, view the RACP Congress 2020 video. We look forward to seeing you in Melbourne, Monday, 4 May to Wednesday, 6 May 2020.
Don’t miss out on applying for positions as a part of the 2019 Advanced Training Selection and Matching (ATSM) service.
Many positions open next week however, you must complete your registration before you can apply. This includes completing a standardised CV template and referee reports from your nominated referees.
Register now so you will have enough time for your referees to complete and return their report before applications close.
Please note, some positions in gastroenterology, geriatric medicine, rehabilitation medicine, and respiratory and sleep medicine are only open for a very short period of time.
1. Check the key dates to see which specialty groups in which states are using the ATSM service in 2019.
2. If there is a specialty you would like to apply for, please register as soon as possible. You must register online before you can apply for a position.
As in previous years, ATSM is used by a small number of specialties and locations to advertise positions. All other positions will be advertised on training site websites or other recruitment sites. You should check the RACP website and employer recruitment websites relevant to your desired training posts.
More information on the ATSM service in 2019 is available on the RACP website.
If you have any queries about the ATSM service please contact Member Services at firstname.lastname@example.org or toll free on 1300 697 227.
If you are seeking support to undertake research, do not miss out on the different awards and grants offered through the RACP Foundation. Applications are closing soon for the following categories:
Full details for these and other opportunities are available on the Foundation webpage.
Ep47: Complex Adolescent Transitions
Everyone knows that adolescence is a turbulent time. Teens are faced not just with changes to their bodies, but to their moods and thought patterns as well. They might also be saying goodbye to familiar carers in the paediatric department, and in Episode 11 we heard how important it is to ensure a smooth transition to adult services, which tend to be more anonymous.
This is especially true for young people with special needs such as diabetes, transplant management or intellectual disability, though they are the least likely to received dedicated transition support. The three speakers in this podcast explain that improving this transition process doesn’t require going way above and beyond regular practice, it just needs a little more coordination.
Recorded at RACP Congress 2019. First, Dr Fran Mouat outlined Starship’s transition program for young patients with diabetes, and some of the data showing its impact on glycaemic control after they’ve left paediatric care.
Dr Rachael Harry leads a transition program for adolescents who’ve undergone transplants early in life. With a moving case study, she described how all the medical care in the world needs to fit in with the lifestyle that every young adult aspires to.
Finally, Dr Colette Muir, described what this period is like for adolescents with developmental disabilities. Intellectual disability is associated with a lower quality of care throughout the lifespan, often because of “diagnostic overshadowing”—the phenomenon by which the complaints of such patients get attributed to the disability itself, rather than being investigated thoroughly in their own right.
The RACP is a signatory to an international consensus statement called Equally Well, and has also published a position paper about transition of young people with chronic disability needs.
The first webinar for the Australian Sleep Association is going live Wednesday 3 July 2019 at 6pm (Canberra, Melbourne, Sydney time). Register in advance for this webinar.
Speakers Professor Siobhan Banks, Jill Dorrian, Charlotte Gupta and Crystal Yates, will present on ‘The impact of meal timings on shift-workers’ performance and health’.
This webinar is part of the Specialty Society Webinar Service that is being undertaken by the RACP in partnership with its affiliated specialty societies.
The Basic Training unit have a new email address. Please make sure you update your email contactto BasicTraining@racp.edu.au.
Emails sent to PREP_BT@racp.edu.au are currently being redirected to the new address. However, this email will soon be switched off.
Please ensure you send all further emails to the new address as any vital information to your training may not be received at the old address.
Expressions of interest are open for a Fellow to join the College Research Committee.
To apply, submit an expression of interest form and your CV (maximum 2 pages) to email@example.com
Include a brief statement outlining your interest in the role and how your knowledge and experience will contribute to the Committee's objectives.
The Australian Digital Health Agency will be holding a national webinar for all healthcare providers, 'Clinical documents in My Health Record explained'.
This webinar will provide insights into the types of provider clinical documents that can be found in an individual’s My Health Record, highlighting the origins and accessibility to different document types as well as clarifying common ambiguities. Areas covered include:
- Shared Health Summaries vs Event Summaries
- Prescription and Dispense Records vs Pharmaceutical Benefits Scheme (PBS) medicines
- Medicines Information View- Pharmaceutical Shared Medicines List (PSML)
- Pathology and Diagnostic Imaging
- Specialist Letters
- Medicare Documents
- Advanced Care Plan and Advanced Care Document Custodian
- Date & Time: Thursday, 18 July 2019 at 1pm to 2pm (AEST)
- Join via your computer – register beforehand. Registrations close 24 hours prior to the event
- A copy of the presentation will be made available following the event to individuals who have registered to attend the webinar.
In July 2018 the College sent a letter to the Pharmaceutical Benefits Advisory Committee’s (PBAC) review of the ‘Doctors Bag’ recommending the addition of syphilis treatment medication benzathine penicillin to enable General Practitioners and other primary care services, including Aboriginal health services, to supply and stock benzathine for syphilis treatment.
In February 2019 the PBAC Secretariat requested further information to support the 2018 submission. A submission was developed by the National Aboriginal Community Controlled Health Organisation (NACCHO) and the RACP’s Sexual Health in Aboriginal and Torres Strait Islander Communities Expert Reference Group (ERG) recommending including benzathine penicillin on the pharmaceutical benefits scheme prescriber bag list (‘Doctors bag’).
The Pharmaceutical Benefits Advisory Committee accepted the recommendation, and this is an important step in increasing syphilis treatment availability to address the syphilis epidemic in Queensland, Northern Territory, Western Australia and South Australia.
Benzathine penicillin in the Doctors Bag will be specifically useful for:
- Non-remote Aboriginal medical service, high caseload urban general practitioners to stock benzathine.
- Any General Practitioners calling a sexual health clinic for advice can be advised that they can order the treatment in for free before the patient arrives to reduce delays to treatment initiation and loss to follow-up.
The closing date for applications for the MSD Hubert Stuerzl Memorial Educational Award 2019 is Friday, 5 July 2019.
The purpose of this award is to encourage education and training in the field of Neuro-Oncology and will provide up to $15,000 for the successful recipient to:
- attend an international Neuro-Oncology scientific meeting
- undertake a Neuro-Oncology Preceptorship during 2019-2020.
Further details regarding the eligibility criteria, application requirements and selection criteria are available on the COGNO website.
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Expressions of Interest – MQ Health Neurology
MQ Health is inviting applications from early-mid career neurologists interested in working as part of our Neurosciences Clinical Program. The successful clinician/s will be engaged under a revenue share license agreement and help support the growth of our Neurology services at MQ Health. We will commit to working with you to build your practice as part of the MQ Health team.
To apply, and for more details, view the full Expression of Interest on the MQ Health website.